Basic Information
Provider Information
NPI: 1710135983
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TRAN
FirstName: CHRISTIE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PHARM.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: VA SAN DIEGO HEALTHCARE SYSTEM
Address2: 3350 LA JOLLA VILLAGE DR
City: SAN DIEGO
State: CA
PostalCode: 921610001
CountryCode: US
TelephoneNumber: 8585528585
FaxNumber: 8585527582
Practice Location
Address1: VA SAN DIEGO HEALTHCARE SYSTEM
Address2: 3350 LA JOLLA VILLAGE DR
City: SAN DIEGO
State: CA
PostalCode: 921610001
CountryCode: US
TelephoneNumber: 8585528585
FaxNumber: 8585527582
Other Information
ProviderEnumerationDate: 08/29/2008
LastUpdateDate: 08/29/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X61514CAY Pharmacy Service ProvidersPharmacist 

No ID Information.


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